Military Health as a Vehicle for Strategic Cooperation in International Fields

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The Portuguese Military Health’s potential in its international context was the subject of an academic study for the National Defense Course 2012/2013 of the Portuguese National Defense Institute. “International Cooperation in the Portuguese Military Health Context – State of the art and brief overview prospective”, authored by Dr. Nuno Caeiro, Chief of the Military Health Division of the Portuguese Ministry of Defense, considers and explores the national military health’s capacity as a vehicle for strategic cooperation in fields as diverse as the European Union (EU), the North Atlantic Treaty Organization (NATO), the Community of Portuguese Speaking Countries (CPSC) or partner countries in the bilateral cooperation context.

Military Health in Portugal

caeiro 1 KopieThe Portuguese Military Health System’s mission is primarily to ensure medical support to the military forces, the maintenance and recovery of appropriate operational capacity to function in the national territory or by the Outstanding National Forces and also to ensure medical care for reservists and retired military and their families, including disabled military.

Providing a crucial support system for the Armed Forces and an increasingly important component in scenarios of international conflict, the need to create a new organization model that can meet the needs, current and future, of the Armed Forces, given the socio-economic context of Portugal, covering the whole of human, material, financial and hospital infrastructure, has been identified over the years. Despite the recognized centrality of Military Health issues, the complexity and sensitivity of the matter have led to a process of gradual and phased reform, which should be totally completed in the coming years and whose greatest achievement is the creation of a single military hospital with two poles, one in Lisbon and the other in Oporto.

Human Resources: Military Health Professionals

The majority of human resources for Health (doctors, nurses, senior health technicians, diagnostic and therapeutic senior technicians, medical action auxiliary personnel and first responders) are currently assigned to the Hospital of the Armed Forces, with the remainder staff scattered by other military health structures. Fig. 2 allows counting a total of 1.388 health professionals belonging to the Military Health System (MHS) in a global universe of 38.049 military (in January 2013).

In the current scenario of reform, the decrease in numbers of health professionals serving in the Portuguese Armed Forces over the past three years is not surprising. Much more than a cut in personnel, as a result of the imposition of the memorandum of understanding concluded in 2011 between the Portuguese Government and the International Monetary Fund, the European Central Bank and the European Commission, this was a trend that was already verified with the implementation of the various measures under the ongoing reform, with a special focus on hospital restructuring.

International Cooperation: Strengths and Weaknesses

The Portuguese Armed Forces develop several activities within the Military Health frame of reference in the various fields of international cooperation, namely:  the North Atlantic Treaty Organization (NATO), the International Committee on Military Medicine (ICMM), the Community of Portuguese Speaking Countries (CPSC) or partner countries in the bilateral cooperation context (Angola, Brazil, Tunisia, Algeria, Morocco and others).

The study identifies, through a SWOT (strengths, weaknesses, opportunities, threats) matrix, the main strengths and weaknes­ses of the Portuguese Military Health (internal environment analysis) and the main opportunities and threats that the international panorama may present to Portugal in the cooperative context with similar entities from other countries (external environment analysis).

From the above mentioned SWOT analysis, the study revealed the following main conclusions:

  • The humanitarian disaster threat that is always present in a minor or major degree and can be caused by a variety of factors, can be mitigated or fought through the encouragement of an effective internal articulation, by means of participation by the Military Health in the response to catastrophe situations focusing mainly on the help that the Military Medical Simulation Centers can provide when combined with the non-military entities that yield the same services; on an external level, a partnership can be promoted with other EU countries, namely Spain for its proximity, in what concerns catastrophe management through the complementarity of human resources and materials or through joint training measures;
  • The bioterrorist threat can be increased by the non-existence of a CBRN (Chemical, Biological, Radiological and Nuclear) pole in Portugal. It is, therefore, necessary to equate the possibility of creating such a pole within our national territory;
  • Being a part of NATO since it’s foundation allows Portugal to have human resources in the Military Health areas that have been trained within the Alliance’s framework; in turn, within the CPSC, the experience and human resources exchanges have been beneficial in the training field by means of implementation of internships; it is, therefore, predictable the increase of such ac­tions. It is imperative that this training of human resources in the areas of Military Health are made profitable;
  • The mutual interest in cooperating with the Portuguese Military Health revealed in recent years by some countries in North Africa such as Tunisia, Algeria and, most recently, Morocco, would seem like an excellent opportunity for Portuguese structures of recognized quality, as exemplified by the Centers for Medical Simulation, the Center for Hyperbaric Medicine and Underwater or the Air Force Medical Center to exchange experiences – either on the scientific or in the operational side – with their international counterparts as the training level of their human resources is the same;
  • With the rising incorporation of technology in clinical practice, increasingly versatile in modern societies, innovation and technological change can best be used by the Portuguese Military Health through further exploration of specific areas such as telemedicine and robotics; the fact that these specific aspects concern still insufficiently exploited domains in the Portuguese Armed Forces suggests a more effective cooperation structure with ­Military Health Partner countries where these areas are more developed, such as Brazil.

Prospective Analysis

The study demonstrates how a prospective analysis of the multiple scenarios that can be explored alongside Portugal’s international partners in this field, can contribute to the full use of all the potential that it has to offer. Taking into account that only the consistent and accurate knowledge and analysis of the past and the present allows the completion of prospective studies, a methodology is presented that permits the definition of strategic goals and the clarification of the means to be employed, allowing to further identify some constraints. Two examples were drawn to demonstrate how useful this methodology can be to all the services that work in this field of expertise.

In this example, the impacts of the existence or absence of a CBRN Centre cross with a high or low threat of this nature. With this exercise, it can be concluded that security will always be superior in a scenario involving its creation than a contrary scenario. It may be an obvious conclusion but the most important thing is that we have four well defined scenarios from which we can assess the probability of occurrence and develop strategic recommendations for each one. Accordingly, this exercise will allow the authorities to establish contingency plans for the possible occurrence of each of the scenarios.

In Example 2, in turn, the impacts of the existence or absence of articulation with Spain cross with the prevention/response to disaster situations. The conclusion is also obvious; ensuring links with this country will result in a higher responsiveness.

As in the previous example, (it is that) we have four well defined scenarios, and from here we can assess the probability of occurrence of each one and develop strategic recommendations accordingly. This exercise allows the definition of contingency plans for each scenario, by the responsible authorities.

Conclusions of the Study

  • Military Health should be seen as an investment and a source of value creation for the country;
  • Military Health must have excellent/high quality services which prove competitive in a perspective of complementarity with the National Health System (NHS) and other structures, as a center of distinctive competencies, whether present in hospital or in specialized structures of military health;
  • Advantages in the conjunction of the Military Health with civilian, national or foreign structures in preventing or responding to humanitarian disasters, maximizing the use of some military health structures with recognized quality for the civil society;
  • Strategic thinking for international cooperation in the Military Health should define the respective political overtones – which targeted countries / which areas of cooperation and technicians – which matters;
  • Advantages of a more effective cooperation with third countries structures in specific areas.